Experience of COVID-19 vaccination among primary healthcare workers in Hong Kong : a qualitative study

Studies show that coronavirus disease 2019 (COVID-19) vaccine hesitancy exists among healthcare workers (HCWs). Past personal experiences of vaccination, such as the seasonal influenza vaccination, influence individuals’ intention to receive future vaccinations. This study aimed to explore the experience of COVID-19 vaccination among primary care HCWs in Hong Kong. A qualitative study using semi-structured interviews was conducted. Twenty-eight HCWs (ten doctors, ten nurses, and eight supporting staff) working in nine government-funded primary care clinics in Hong Kong who had completed at least one dose of COVID-19 vaccination were interviewed. Four themes were generated, namely, the cognitive and emotional battle of vaccine hesitancy, catalysts for vaccine acceptance, blasting vaccination myths, and being a positive influence. Providing timely, adequate, and transparent vaccine information and addressing the specific concerns of HCWs about the COVID-19 vaccine could enhance their vaccination uptake in future. Specific vaccine promotion strategies, such as the sharing of vaccination experiences targeted at different subgroups of HCWs, may improve vaccine acceptance through informational social influence

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Leptin: clue to poor appetite in oxygen-starved fish

Hypoxia is the most widespread deleterious consequence of eutrophication and has become a major cause of fishery decline. One feature of chronic exposure to hypoxia in fish is inhibition of feeding. In this study, we investigated if the gene that encodes the appetite-suppressing hormone leptin is regulated by hypoxia in zebrafish (Danio rerio). Exposure of adult zebrafish to hypoxic conditions (1 ± 0.2 mg O₂ L⁻¹) for 4 and 10 days significantly increased leptin-a (zlep-a) mRNA levels in the liver. To evaluate the role of hypoxia-inducible factor 1 (HIF-1) in regulating zlep-a expression, zebrafish embryos were exposed to cobalt chloride (CoCl₂, a HIF-1 inducer) and overexpressed with HIF-1α mRNA. Both CoCl₂ treatment and HIF-1α overexpression markedly increased zlep-a expression in developing embryos, indicating the possible involvement of HIF-1 in zlep-a regulation. In vivo promoter analysis indicated that zlep-a promoter activity is found in the muscle fibers of zebrafish embryos and enhanced by CoCl₂. This is the first report to show that leptin gene expression in fish is regulated by hypoxia possibly via the involvement of HIF-1

Factors affecting prescription of sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus with established cardiovascular disease/ chronic kidney disease in Hong Kong : a qualitative study

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2 I) has cardiorenal protective properties and are recommended for patients with diabetes and established atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). Although cardiorenal complications are high in diabetes and pose a signifcant fnancial burden on the Hong Kong health care system, the use of SGLT2 I in these populations remains low. And yet this issue has not been explored in Hong Kong primary care. This study aimed to explore factors afecting primary care doctors’ prescribing of SGLT2 I in patients with diabetes and established ASCVD/CKD in Hong Kong. Methods: A phenomenological qualitative research using semi-structured interviews was conducted between January and May 2021 in one Hospital Authority cluster in Hong Kong. Purposive sampling was employed to recruit primary care doctors in the cluster. The Theoretical Domains Framework (TDF) underpinned the study and guided the development of the interview questions. Data was analysed using both inductive and deductive approaches. The Consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide the reporting. Results: Interviews were conducted with 17 primary care doctors. Four overarching themes were inductively identifed: knowledge and previous practice patterns infuence prescription, balancing risks and benefts, doctors’ professional responsibilities, and system barriers. The four themes were then deductively mapped to the nine specifc domains of the TDF: knowledge; intention; memory; beliefs about capabilities; beliefs about consequences; goals; role and identity; emotion; and environmental constraints. Most interviewees, to varying extent, were aware of the cardio-renal advantages and safety profle of SGLT2 I but are reluctant to prescribe or change their patients to SGLT2 I because of their knowledge gap that the cardio-renal benefts of SGLT2 I was independent of glyacemic efcacy

Nurses' attitude to seasonal influenza vaccination in primary care outpatient clinics : a qualitative study

Objective: To explore the attitude of nurses towards seasonal influenza vaccination (SIV) in primary care outpatient clinics in Hong Kong Design: A qualitative study. Subjects: Primary care nurses at 11 primary care outpatient clinics in the New Territories West cluster of the Hong Kong Hospital Authority. Main outcome measures: Vaccination status in the Hospital Authority 2018/2019 SIV programme, views on perceived susceptibility and severity of influenza, effectiveness and risk of SIV and views on SIV provision. Results: Twenty nurses participated in the study. The key motivating factor for vaccination was a strong belief on the effectiveness of vaccination. The major factor deterring vaccination was a strong belief on alternative measures to prevent influenza other than vaccination. The unvaccinated nurses had more fear of the side-effects of the vaccination, although they accepted the scientific evidence supporting SIV safety. The current SIV provision at workplace was practically barrier-free, but there were concerns with personal data privacy. Mandatory SIV campaign was opposed. Conclusions: There are varied attitudes of the nurses towards SIV amongst the unvaccinated and vaccinated nurses in primar y care clinics. Further directions of repackaging the SIV campaign might focus on respecting personal privacy and autonomy, emphasising patient protection with vaccination, and the peer-driven culture of vaccination

Hong Kong Chinese adults’ knowledge of exercise recommendations and attitudes towards exercise

Background: Physical inactivity is known to be one of the major risk factors for many chronic conditions. Aim: To determine Hong Kong Chinese adults’ physical activity (PA) knowledge, its relationship with certain variables including sex, education, age, and its correlation with different types of chronic diseases, such as heart disease, cerebrovascular disease, diabetes mellitus, obesity, and others. The Hong Kong Chinese adults' general attitudes towards PA will also be examined. Design & setting: Cross-sectional study in one primary care centre. Method: A randomized sample of Chinese adults aged >18 years with anonymous self-administered questionnaires. Results: The mean percentage of correct responses for exercise guidelines was 62.3%, 84.5% for traditional PA, and 48.4% for lifestyle PA, respectively. Traditional PA refers to exercises which use large muscle groups. Lifestyle PAs include activities which can be done throughout the day. The total mean percentage of correct responses was 67% (knowledge score 13.4 +/– 3.34). There were no significant differences between PA knowledge and sex, education levels, age groups, and presence of chronic diseases (P>0.05), but the knowledge level for lifestyle PA was less than that of traditional PA (P0.05). Two hundred and sixy-six (93.3%) responders reported a willingness to maintain or start exercise. Conclusion: The results suggest a need for more education about the latest PA recommendations, especially lifestyle PA. The weak correlation between PA knowledge and actual behaviour showed that PA knowledge itself might not affect PA behaviour. The enhancement of the general public’s knowledge, motivation, and psychosocial support along with stage-of-change interventions and the provision of counselling skills may result in PA behaviour change, which in turn can lead to the achievement of health benefits

Risk factors of chronic kidney diseases in Chinese adults with type 2 diabetes

Abstract In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63.0 (±10.8) years and mean DM duration of 7.4 (±6.4) years. Of them 9,386 (29.7%) had CKD and 7,452 (23.6%) had micro- or macro-albuminuria. After adjustment for multiple demographic and lifestyle confounders, we identified several modifiable risk factors associated with higher rate of CKD: obesity (OR = 1.54), current smoking (OR = 1.33), higher systolic blood pressure (OR = 1.01), dyslipidemia (OR = 1.32 and 0.61 for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)), hyperglycemia (OR = 1.11 for HbA1c), diabetic retinopathy (OR = 1.36 and 2.60 for non-sight and sight threatening retinopathy), and stroke (OR = 1.43). The risk factors of lower dialytic blood pressure and coronary heart disease were identified only in men, whereas peripheral arterial disease only in women. In conclusion, several modifiable and gender specific risk factors were significantly associated with higher prevalence of CKD in Chinese adults with T2DM. The high-risk populations identified in this study shall receive regular screening for renal functions to achieve better patient management in primary care settings

Outcomes of a risk assessment and management program using telecare consultation among patients with diabetes mellitus in general out-patient clinic: a hybrid effectiveness-implementation study protocol

AbstractDiabetes Mellitus (DM) is a chronic disease characterized by abnormally uncontrolled high blood glucose level. The Risk Assessment and Management Program (RAMP) in Hong Kong has been providing long-term face-to-face follow-up to DM patients in the government out-patient clinics since 2009. However, under the current outbreak of COVID-19, these face-to-face consultations were ceased over and over again to lower the risk of disease transmission. With the advancement in technology, the recent emergence of telecare has provided an alternative to replace the conventional consultations in the clinics. Its clinical effectiveness on DM patients has also been supported by numerous studies. Yet, there is only a paucity of literatures discussing the practicality of such implementation design in the real-world settings. This study aims at studying both the effectiveness and implementation outcomes of telecare in Hong Kong DM patients. It adopts a type 2 hybrid effectiveness-implementation design. It will be conducted in seven government out-patient clinics in Hong Kong. The subjects will be randomly assigned to an intervention group or a control group when they 1) are aged 18 or above, 2) have a confirmed diagnosis of diabetes, and 3) are having regular follow-up appointment in the clinic. Subjects in the intervention group will receive a 84-week Risk Assessment and Management Program (RAMP) in an alternate telecare and face-to-face consultations mode, while the control group will receive the same program but in usual face-to-face consultation mode. RE-AIM is employed as the implementation and effectiveness outcome evaluation framework. The primary outcome measure will be HbA1c. Data will be collected pre-intervention (T1), 42-week (T2), and 84-week (T3). The study will provide effectiveness-implementation assessment of telecare mode for DM patients in Hong Kong, as an alternative or in addition to conventional face-to-face consultations. It also aimed to provide insights for the future adoption in a broader health care setting

Leptin-mediated modulation of steroidogenic gene expression in hypoxic zebrafish embryos: implications for the disruption of sex steroids

Hypoxia can impair reproduction of fishes through the disruption of sex steroids. Here, using zebrafish (Danio rerio) embryos, we investigated (i) whether hypoxia can directly affect steroidogenesis independent of pituitary regulation via modulation of steroidogenic gene expression, and (ii) the role of leptin in hypoxia-induced disruption of steroidogenesis. Exposure of fertilized zebrafish embryos to hypoxia (1.0 mg O₂ L^–1) from 0–72 h postfertilization (hpf), a developmental window when steroidogenesis is unregulated by pituitary influence, resulted in the up-regulation of <i>cyp11a, cyp17</i>, and <i>3β-hsd</i> and the down-regulation of <i>cyp19a</i>. Similar gene expression patterns were observed for embryos exposed to 10 mM cobalt chloride (CoCl₂, a chemical inducer of hypoxia-inducible factor 1, HIF-1), suggesting a regulatory role of HIF-1 in steroidogenesis. Testosterone (T) and estradiol (E2) concentrations in hypoxic embryos were greater and lesser, respectively, relative to the normoxic control, thus leading to an increased T/E2 ratio. Expression of the leptin-a gene (<i>zlep-a</i>) was up-regulated upon both hypoxia and CoCl₂ treatments. Functional assays suggested that under hypoxia, elevated <i>zlep-a</i> expression might activate <i>cyp11a</i> and <i>3β-hsd</i> and inhibit <i>cyp19a</i>. Overall, this study indicates that hypoxia, possibly via HIF-1-induced leptin expression, modulates sex steroid synthesis by acting directly on steroidogenic gene expression